A debate has erupted in the scientific and advocacy worlds on long-acting contraceptives and the importance of women’s preferences in contraceptive care. While women’s agency in decision-making is essential for all contraceptive choices, it is especially relevant for long-acting methods that require a clinician visit.

In order to ensure that contraceptive care respect women’s fundamental rights, we need to be able to measure women’s autonomy and preferences, as well as their interactions with providers. However, a scientific gap exists in the conceptualization and measurement of women’s autonomy and contraceptive decision-making.

We propose to use a novel technique in reproductive health research, Item Response Theory, to rigorously develop and test women’s autonomy in contraceptive decision-making. This new measure will advance contraceptive research and evaluation of clinical services. It can also help to improve contraceptive programs and policies in an essential way by offering a valid and reliable tool for current discussions about national metrics for family planning services.

Without a rigorous measure of women’s autonomy, it may be too easy to focus on other quantifiable measures and contraceptive goals that can lead to erosion of women’s autonomy. Finally, advocates can have access to data evaluating whether contraceptive services align with their goals. The consideration of women’s autonomy, not only as a guiding principle, but as a measurable aspect of contraceptive care, can help to move women’s autonomy from an aspirational goal to a visible and concrete part of care.